HAND HYGIENE PRACTICES AMONG NURSES IN UNIVERSITY OF PORTHACOURT TEACHING HOSPITAL, RIVERS STATE

ABSTRACT
Background: Health care workers ‘hands are the main route of cross transmission of harmful germs to the patient when they are not clean. The main way to reduce cross transmission is handwashing. That is why nurses need to have knowledge on handwashing, which will influence their best practice and adherence to infection control measures.

Aim of the study: The present study aimed to evaluate hand hygiene knowledge and practices of nurses for infection prevention in neonatology at a selected district hospital.

Research methodology: Quantitative approach using cross sectional descriptive study was used to describe the level of knowledge and practices of nurses on handwashing for infection prevention in neonatology. A total sample of 50 nurses working in maternity and neonatal unit was used. An anonymous self-administered questionnaire was used to collect data and out of 50 questionnaires distributed 50were returned back completed.

The data analysis was done using SPSS 20. The results demonstrated a mean knowledge of78.09% and standard deviation (SD= 6.9), the mean score for practice was 71.27 (SD=19.6).Among 50 nurses who participate in the study 36 72% of respondents have goodknowledgeand2346%have goodpracticeabouthandwashing.Therewasnotassociationbetweendemographicdataandhand hygiene knowledge, the association was between the department of work and the practice of hand washing with the significant level of p= 0.012.However,theresultsdidnotshowany relationship between handwashing knowledge and practice of nurses.

Conclusion: This study recommends improvement in services training that may help to increaseknowledgeand practiceamongnurses on handwashingandfutureresearch.

CHAPTER ONE
INTRODUCTION
1.1.backgroundtothestudy
Thischapterprovidesthebackgroundofthestudy,showingtheprevalenceofhealthcareassociated infection and the data on the role of handwashing as important component of infectionprevention to reduce HCIs in neonatology. In this study handwashing and hand hygiene wereusedinterchangeably.

Health care-associated infections (HAIs) are one of the most common adverse events in caredelivery and a major public health problem with an impact on morbidity, mortality and quality oflife (WHO, 2016, p. 9). At any given time, up to 7% of patients in developed and 10% indevelopingcountries willacquire at leastone HAI(WHO, 2016, p. 9).

In sub-Saharan Africa,the data available show that the incidence ofnosocomial infectionsranges from 2-49% with patients in intensive care units having the highest rate ranging from 21.2to35.6% (Elizabeth, 2016, p. 1).

Globally,seriousneonatalinfectionscauseanestimated36%ofneonataldeaths.Insomesettings where mortality rates >45% per 1000 live births, neonatal infections are estimated tocause 40% to 50% of all neonatal deaths (Darmstadt, Zaidi and Stoll, 2011, p. 1). About 30-40%ofinfectionsresultinginneonatalsepsisdeathsaretransmittedatthetimeofchildbirth(Blencowe et al., 2011, p. 2). In developed countries incidence of neonatal infections in NICUsrangefrom 6%to 25% (UwaezuokeandObu, 2013, p. 1).

According to the Report on the Burden of Endemic Health Care-Associated Infection WorldwideClean Care is Safer Care (2011, p. 18), neonatal infection rates in developing countries are 3 to20 times higher than in industrialized countries and among hospital-born babies these infectionsare responsible for 4% to 56% of all causes of death in the neonatal period, with the ¾ occurringintheSouth-East AsiaRegionand Sub-SaharaAfrica.

In Rwanda among the causes of neonatal mortality in 2010 sepsis was 29% (Surveys, 2010, p. 3). In 2012 neonatal mortality due to infection was 16%(MOH,2012,p.41),in2013neonatal mortality due to neonatal infection was11% (Statistics booklet, 2013, p. 43) and in 2014 neonatal mortality was 9%, dueto infections among others causes. (Statistics, 2014, p. 39).

Hand hygiene is the primary measure proven to be effective in preventing HCAI and the spreadof antimicrobial resistance (WHO, 2009b, p. 5). In addition, proper hand hygiene is the singlemost important, simplest, and least expensive means of reducing the prevalence of HAIs and thespread of antimicrobial resistance in health care setting (Mathur, 2011, p. 3). A study done by,(Lam et al., 2004, p. 1) show an increase inhand hygiene compliance from 40% to 53% beforepatient contact and 39% to 59% after patient contact. More marked improvement was observedfor high-risk procedures 35%–60%, that compliance with hand hygiene reduces the health care–associatedinfection ratefrom 11.3 to 6.2per 1000 patient-days.

However, Lack of knowledge on infection prevention among nurses can increasetherateofHCAs.Thisissupportedbyastudydoneby,Mohesh(2014),showeddifferentlevelofknowledgeonsomeelementswherehandhygienecanpreventinfection,50%ofthemaccepted that, hand hygiene practices before and after handling a patient will prevent health careassociated infections. Although 94% agreed, 6% refused that hand hygiene as an importantpreventive measure for cross infections. 95% of them washed their hands before and after theirfood intake.70% of them used soap and water whereas only 6.36% used alcohol based agents(Mohesh,2014, p. 2).

Inaddition,nursesareengagedindirectcontactwiththenewbornwhiledelivering care, so they have an important role in infection control. Ensuring that nurses recognize theimportance of handwashing in prevention of HCAs, know whenandhow handwashing should be performed, and fellow recommended practice is important. In thiscontext, the present research aimed to evaluate handwashing‘ knowledge and practice of nurses for infection prevention in University of Porthacourt Teaching Hospital. The findingsfromthisstudyshouldbeaddedtotheexistingliteratureandmaybeusedtodevelopinterventionsto reducethespread ofinfection in neonatology.

1.3 Problem statement
Inthehospitalsettings,infectionsaretheone ofthecauseofneonatalmortality.Rwandademographic and healthsurvey 2014-2015 reported that neonatal mortality was20/1000 livebirth (RDHS, 2015, p. 15). Neonatal mortality due to infections was 16% reported in Rwandaannual health statistics 2012(Ministry of health, 2012, p. 41). In 2014 neonatal mortality due toinfection was decreased to 9% (RDHS, 2014, p. 48). Even though, there is a decrease but theproblem still existing. In Uniport hospital among 2142 neonates admitted in neonatology in2016, 514 24% were reported to have neonatal infections during hospitalization (Uniporthospitalannualreport,2016).AccordingtoMOH(2012),neonatologyclinicaltreatmentguideline insist on hand washing(Minister of health, 2012, p. 6). The critical role of nurses inpatient care emphasis on the role of the control hospital acquired infections, but good knowledgeand skills are required for infection control (Fashafshehet al., 2016, p. 2).However, health carestaff ‘s Knowledge and practice on handwashing are important in the prevention of infections. Inthe selected district hospital in Rwanda, it is not known how nurses‘ knowledgeandpracticeonhandwashingis.Thisstudyintendedtoevaluatenurses‘knowledge and practices on handwashing for infection prevention in neonatology at UniportHospital.

1.4 Objectives
1.4.1 Mainobjective
To evaluate the knowledge and practices of nurses on hand hygiene and infectionpreventionin University of Porthacourt Teaching Hospital.

Specific objectives
1. Assess the level of knowledge of nurses on hand hygiene and infection preventioninUniversity of Porthacourt Teaching Hospital.

2. Identify the practices of nurses on hand hygiene and infection prevention inUniversity of Porthacourt Teaching Hospital.

3. Identify the barriers to handwashing practices and infection prevention in University of Porthacourt Teaching Hospital.

1.5 Research questions
1. What level of knowledge of nurses on hand hygiene and infection prevention inneonatologyat a selecteddistrict hospital?

2. Whatarepracticesofnursesonhand hygiene and infectionpreventioninUniversity of Porthacourt Teaching Hospital?

3. What are the barriers to handwashing practice and infection prevention in neonatology at aselecteddistrict hospital?

1.6 Significance of the study
The study of knowledge and practices of nurses on hand hygiene and infectionprevention in neonatology at a selected district hospital will boost the nurses to expand theirtherapeuticstrategiesandinitiateappropriateprogramsinordertoimprovethelifeofneonatesby covering the gap that already has been existing in follow up or management of neonates andnarrow the burden of infections in general and more specifically health care acquired infection inUniversity of Porthacourt Teaching Hospital. In addition, the study will motivate other researchers toconduct further researches on health care acquired infections in neonatology in order to improvethelives ofthe community.

1.7. Definition of concept
Handwashing: according to WHO (2009, p. 2)hand washing is a hand hygiene practice thatrequireswashinghandswith plainorantimicrobial soapandwaterasisthecaseinthis study.

Knowledge: according to Colour Oxford English Dictionary (2011, p. 384) knowledge is definedasinformationandawarenessgained thoughexperience oreducation.Inthisstudy projectknowledge refers to information and skills of nurses about hand washing forinfectionprevention in University of Porthacourt Teaching Hospital.

Practice: according to Colour Oxford English Dictionary (2011, p.536) practice refers to dosomethingregularlyaspartofyournormalbehavior.Thewaynursesinneonatologyand maternityincorporate handwashingwhen deliveringcare.

Health care associated infection: according to WHO (2011, p, 10), health care associatedinfection is an infection occurring in a patient during the process of care in a hospital or otherhealth-care facility which was not present or incubating at the time of admission. In this studyHCAs is considered as an infection that a newborn baby contracted when he/she is hospitalizedforotherpr0blems.

Neonate: according to Stanford a newborn is a baby aged from 0 to 28 days. In this a neonate iseverybabythis agemayaterm, preterm, orpost term.

1.8. Organization of study
Thisthesisisdividedintofivechapters.Thefirstchapterisintroductionanditincludesbackground to the study, problem statement, and objectives of the study, research questions, andsignificance of the study. Chapter two includes introduction, theoretical literature, critical reviewand research gap identification, conceptual framework and summary. Chapter three is composedof introduction, research design, target population, sample design which includes simple size andsimple technique, data collections methods which includes instrument, reliability and validity,data analysis procedure and ethical consideration. Chapter four presents results and findings;chapter five dealswithdiscussion of thefindings whereas the lastchapter presentsconclusionandrecommendations.

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Item Type: Project Material  |  Attribute: 44 pages  |  Chapters: 1-5
Format: MS Word  |  Price: N3,000  |  Delivery: Within 30Mins.
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